ECG EKG rhtythm strip criteria
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- Normal Sinus Rhythm
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Rate: 60-100 beats/min
Rhythm: Regular
P Waves: Present, ↑, one before every QRS
PR Interval: ≤ .20
QRS: .08-.12 - Sinus Brady
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All normal criteria except a rate < 60
Rate: < 60
Rhythm: Regular
P Waves: Present, ↑, one before every QRS
PR Interval: ≤ .20
QRS: .08-.12 - Sinus Tachycardia
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All normal criteria except a rate > 100
Rate: > 100
Rhythm: Regular
P Waves: Present, ↑, one before every QRS
PR Interval: ≤ .20
QRS: .08-.12 - Sinus arrhythmia
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Rate: 60-100 beats/min
Rhythm: Irregular
P Waves: Present, ↑, one before every QRS
PR Interval: ≤ .20
QRS: .08-.12 - Sinus Block
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Rate: 60-100 beats/min
Rhythm: Irregular due to pause. When you measure the R-R interval it will fit exactly in the pause
P Waves: Present, ↑, one before every QRS
PR Interval: ≤ .20
QRS: .08-.12 - Sinus Arrest
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Rate: 60-100 beats/min
Rhythm: Irregular due to the pause. When you measure the R-R Interval, it will not fit in the pause
P Waves: Present, ↑, one before every QRS
PR Interval: ≤ .20
QRS: .08-.12 - Premature Atrial complex (PAC)
- The complex will come early and will have an upright P wave (usually a little skinner and taller than normal). Will have an irregular rhythm due to early beat. The underlying rhythm is usually sinus
- Atrial Tachycardia
- Rate will be > 150 with a visible P wave (There will be two humps between each complex)
- Supraventricular Tachycardia (SVT)
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Rate: > 150
Rhythm: Always Regular
P wave: No visible P waves (One hump between each QRS complex) - Wandering Atrial Pacemaker (WAP)
- Will have three different shaped P waves in 6-sec strip, will have a regular rhythm. It is rare. Due to different places in the atria trying to pace the heart.
- Multifocal Atrial Tachycardia (MAT)
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A WAP with a rate > 100
Never use electricity to treat only drugs - Atrial Flutter
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Sawtooth or picket fence baseline
Cannot tell P’s from T’s
Atria is firing faster than the ventricle
Can be regular or irregular
If rate is > 100 uncontrolled ventricular response
If rate is < 100 controlled ventricular response - Atrial Fibrillation
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Most common dysrhythmia
Will have at least two out of three criteria
-chaotic baseline
-irregular rhythm-ALWAYS
-no identifiable P wave
If rate is > 100 uncontrolled ventricular response
If rate is < 100 controlled ventricular response - Wolf Parkinson White Syndrome (WPW Syndrome)
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Will have a delta symbol in QRS
Significance: Pt. is predisposed to lethal dysrhythmia’s because of vulnerability - Junctional Rhythms (Rate: 40-60 beats/min)
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-The rhythm is ALWAYS regular
-Will be no P wave or an inverted P wave - Premature Junctional Complex (PJC)
- Early beat with no P wave or an inverted P wave
- Accelerated Junctional Rhythm
- Rate > than 60 with no P wave or and inverted P wave
- Junctional Tachycardia
- Rate > 100 with no P wave or inverted P wave
- Junctional Escape Beat
- A Junctional beat that comes late. Beat will have no p wave or inverted P wave that will come late
- Premature Ventricular Complex (PVC)
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Early complex with wide, bizarre QRS
-unifocal: 2 PVCs that look alike
-multifocal: 2 or more PVCs that don’t look alike
-couplet: 2 PVCs in a row
-bigeminy: every other beat is a PVC
-trigeminy: every third beat is a PVC - Idioventricular Rhythm (IVR)
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Rate:20-40
Normally regular rhythm
Will have all ventricular beats (wide, bizarre QRS): - Accelerated IVR (AVIR)
- Rate > 40 with all ventricular beats
- Ventricular tachycardia
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Can be monomorphic V-Tach (Same shaped QRS) or polymorphic tach ( different shaped QRS)
With monomorphic v-tach-check to see of they have a pulse or not
if yes with pulse give O2, IV acess
If no pulse defib
If unstable with pulse Cardioversion - Torsades de Pointe
- polymorphic v-tach
- Short Run of V tach
- 3 or more PVCs in a row
- Ventricular fibrillation (v-fib)
- Rate, rhythm, P wave’s, QRS, cannot be identified. Just looks like line is quivering (fibrillation)
- Asystole
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Total absence of ventricular activity
There will be very little quivering of the baseline
No pulse, No rate, No rhythm, No activity
Action CPR, IV access, transcutaneous pacing, medication therapy - Pulseless Electrical Activity (PEA)
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Rhythm will appear to be normal, but the patient will have no pulse
Nothing is wrong with the electrical system of the heart, but the mechanical system is not working
Action CPR
The most common cause is hypovolemia - 1st degree Heart Block
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All is normal except the PR interval is Greater than .20
Will have the same number of P’s as QRS’s - 2nd degree Mobitz I (Wenkebach)
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Will have more P’s than QRS’s
The PR interval will longer until the QRS gets dropped (the cycle will repeat) - 2nd degree Mobitz II
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Will have more P’s than QRS
The PR interval will be the same for each complex - 3rd degree Complete Block
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Will have mores P’s than QRS
PR interval will vary (no pattern) TREAT WITH PACEMAKER + Atropine